Monday, April 11, 2016

You Are Most Welcome

Gala Girls 2016
Sitting on the beach with our toes in the sand and the waves crashing on shore, it's near impossible to reflect fully on this journey. The past five weeks have been filled with smiles, sweat, tears, laughter and most of all, learning. We learned that the health of a country is multifaceted. So many pieces influence a person's health, and therefore improving the health of a country is complex. There are projects we have here that are continuous, like Chanshegu's health center and Project GROW, and there are smaller projects, like sexual health and relational practice teaching. Sometimes we felt as if what we were doing was not making a difference, yet on some level we know it did. Even if only to one person, us individually, or to someone back home raising their awareness of global health.

The kindness and warmth we were welcomed with was unanimous across the country, coming from old and new friends. If it were not for the amazing partnerships we have here in Ghana, we would not have been able to accomplish what we did. Our long term relationships are wonderful and they allowed us to build on past projects and happily helped us create new ones.

It is our last night in Ghana. This amazing place has stolen our hearts and become a home to us. We came here with our teacher as a mismatched group of UBCO nursing students, and have grown into a family. What we experienced will never be fully understood or mean as much to anyone as it does to us.

We will return to Canada full of stories to share and the responsibility to spread awareness. The Ghana many people see, the beautiful beach resorts and national parks, is nothing compared to what lies beyond the concrete roads.

While we would like to believe our time here made a difference to the people of Ghana, we think Ghana made a bigger difference in each of us. We will never forget the kindness, the love, and lessons this country has given us.

-The Ghana Girls of  2016

From Gala to Ghana

While planning the Global Gala this year it was often difficult to imagine how the money we raised would impact the lives of Ghanaians. At times it was frustrating to be planning an event where we could not say exactly where the money was going.The question of why we could not provide tax receipts was often asked. Up until now I did not fully understand the reason. The Global Gala and the Global Nursing Citizens are not NGOs, and are not able to issue tax receipts for donations.  This definitely creates some challenges when soliciting funds back home, but what we have learned is that this model is better for our partners in Ghana.  We have more flexibility with the funds once we enter into the communities and talk to them about their needs and priorities.  When we are fundraising at home, we have a sense of what's required but do not know for sure until we are on the ground, working with the community. 

 I thank each and every donor for donating despite not receiving a tax receipt and for trusting that funds would be allocated appropriately. I was able to see first hand how it was beneficial to have freedom with our funds.  This year we were able to:
  1. Bring running water into the community health clinic at the village of Chanshegu. This included completing the plumbing, bringing water from the main line into the clinic, buying a large polytank to store water, and paying the fee to tap into the water distribution line.   
  2. Provide funds to secure the land title of the community health clinic at Chanshegu.  
  3. Complete the electricity project at the Okanagan Community Clinic in Nyoboko.
  4. Seal the roof and ceiling of the Okanagan Community Clinic once the electricity project was complete
  5. Purchase of cement and materials to begin the nurses' accommodation at the Okanagan Community Clinic  
  6. Provide a scholarship to a very bright Ghanaian BSN student to enter into Community Development graduate studies at UDS (this student is a testimony to hard work, perseverance, dedication, and never giving up on your dream).
  7. Honorariums to organizations doing amazing work including Dr. Abdulai's Shekhina clinic in Tamale, and Mother of Mercy Orphanage in Sirigu.     
  8. Purchase 2 donkey carts for Project GROW
  9. Purchase medication and supplies for community health screening. 
I understand now that the many hours we put into the Global Gala were worth it.  I wish I knew then what I know now!
Gala Girls - Kath, Dawn, Nicole, Madi, Kelsey and Mel

~ Nicole Elliot

The Power of Giving - Project GROW

The Women of Project GROW
Give a man a fish he'll eat for a day, 
teach a man to fish he'll eat for life.

Empowerment is a word we have used often throughout this trip. While teaching our Ghanaian colleagues about relational practice we touch on empowerment as being an important aspect of nursing.
We had an opportunity to see empowerment in it's purest form.  Our final day in practice was spent in the community of Nyoboko celebrating Project GROW (Ghanaian Rural Opportunities for Women). This is a powerful event because we witness how the money raised by our Canadian community is used to empower Ghanaian women.  Project GROW uses the funds to directly purchase what is required by the women of the community, based on their needs.  This simple model places the trust and faith in the women to identify who is most in need and what the priorities are.  There is no overhead and every dollar donated in Canada goes directly into the community.  The MC for the day captured it beautifully:  "when you give a man power he chooses what to do with that power and sometimes it's not always the right thing. But when you give a women power she empowers her husband, her family and her community." Thus, giving women the ability to earn a wage by selling her goat's milk, using the donkey and cart to get her goods to the market or her crops from the field, and learning to sew in the vocational centre, not only improves her well-being and the well-being of her family, it builds community capacity.

The Goats!
Women in dresses of all colours sang and danced, greeting the chief and then us. This year's ceremony was the biggest one yet, 4 donkeys with carts were donated to communities, there were 52 goats donated, and the vocational centre was officially opened. Women who receive goats are required to donate the first female offspring of the goat back to project GROW to be passed on to another women, and this year there were 16 returning goats, bringing the total to 68 goats.  This year, Project GROW expanded into several new communities and it was wonderful to see the donkeys and goats headed down the gravel road to their new homes.  Some of them had a long walk home but everyone had a smile on their face.
Jeanette's dad's donkey "ED"

Project GROW would not exist without the amazing Dr. Vida Yakong. Vida was born and raised in Nyoboko. Her graduate studies focused on the health disparities in the northern region of Ghana. She found that when women in communities were empowered they were healthier and  overall the community had better health. We want to extend a huge thank you to Vida, Philomena, Josbert, and Jonas for making this day possible and graciously welcoming us during our time in Ghana. 

- Nicole Elliott 

Sunday, April 10, 2016

Okanagan Community Clinic Nyoboko

Okanagan Community Clinic Team
Last week we had the opportunity to spend 3 days at the Okanagan Community Clinic in Nyoboko working with the staff to provide health screening, help with child welfare clinics and connect with the community. This clinic is very dear to our hearts as it was built in collaboration with UBC alumni Dr. Vida Yakong. It is one of the newest clinics in the area as well as one of the most rural. Although the clinic has been operating for a year and a half it still does not have electricity, running water or a nurses' residence. The nurses stationed at the clinic are commuting anywhere from half an hour to an hour from their homes into work everyday. Despite the set backs created by the lack of resources at the clinic, the staff working there are some of the most innovative, resourceful and compassionate healthcare workers we have met along our journey.

Jeanette told us many stories of an incredible nurse named Philomon who was running the clinic all by himself when the students visited last year. Sadly, Jeanette informed us that he had been reassigned to a different site in Ghana, however, on our arrival to the clinic we were surprised to see Philomon himself there to greet us. It was a wonderful surprise and a very joyful reunion  as Jeanette was not expecting to see him at all! Even more amazing is that there are now 5-6 nurses working at the clinic along side Philomon...a very exciting improvement from last year!

Health Screening and Child Welfare Clinic
Word of our health screening had been spread throughout Nyobok and first morning at the clinic, rows of benches were filled with people eager to address their health issues. Spending the day with these community members gave us a sense of how tightly knit the community of Nyobok is. It was amazing to see the turnout of individuals who wanted health screening, and who are now registered clients of the clinic. In the three days we were at the clinic we screened over 200 individuals, which was slightly overwhelming for the staff who usually only see 10-15 clients on average per day. Although it was busy, the staff were happy to see the community come together and share this experience with us.

As the first day was winding down, we heard that there was a young woman who had just given birth
Nyboko Ambulance
in the community without medical assistance. Stephanie went with Philomon and Lillian (another nurse at the clinic) to provide this woman and her new baby with care. Traveling via motorbike they cruised through rural, northern Ghana along small, well-used trails that connect residence to residence. When they arrived at the compound of traditional mud-hut, they found this women to be experiencing a postpartum hemorrhage. All three nurses intervened quickly and Philomon rushed to arrange for transport so that this woman to get the help she needed. The newborn baby boy was healthy and doing well at this time. When the transport arrived Stephanie was amazed to see that the motorized tricycle carriage was provided by Project GROW and had been donated by Gifts to Grandmothers and St. Charles Garnier Catholic Church in Kelowna. Had this carriage not been available, this new mother would have had a very difficult time getting the care she needed. It was amazing to see the direct impact that donations from our community at home make. The woman and her new baby received the care they needed and returned back to their home the next morning.

Child Welfare Clinic
On our last day at the clinic Philomon organized a Child Welfare Day where mothers could bring in their infants and toddlers to measure their weight and to receive vaccinations if needed - this information was then marked in their child's personal health book to keep track of their development. If any child was underweight a nurse would educate the mother about proper nutrition, how to maintain a proper weight and do a further assessment if required. This hectic day ran later than our past two and so everyone was feeling quite drained of energy by the end...luckily we had some impromptu entertainment by a large group of school kids who were playing "copy-cat" in the field behind the clinic with our fellow students, creating a lot of laughter from the staff as well as the patients still waiting to be seen.

Our days at the Nyobok Clinic gave us a lot of joy and made all of us appreciate the work that we do at home in raising funds to support clinics just like this one. Although it was frustrating at times where we were unable to communicate with the community members we found that these were always followed by opportunities to soothe a crying baby or provide comfort to an elderly women by giving her a back rub; all actions not requiring a word.

We can't wait to return one day to see the progress our continuing support will bring to this amazing community!

-Mairi Horth, Victoria Cluett, Mara Macauley, Stephanie Townsend and Shannon Macdonald

Thursday, April 7, 2016

Sexual and Reproductive Health

Logre Jr. High School
This week we taught sexual and reproductive health at two junior high schools. Although we were teaching in similar settings at both schools, our experience varied drastically between the two environments.  At Lorge Junior High we had a formal greeting with organized introductions to students and staff. The students readily split themselves into two groups of girls and two groups of boys. We were not only impressed by the student's cooperation and respect, but also their knowledge on the subject of sexual health. Starting with a solid foundation of anatomy, we were able to work with the students to further their understanding of healthy relationships, pressured and unwanted sex, and violence against women. We finished off this teaching session by
Days for Girls Kits
sharing our Days for Girls menstruation and hygiene kits with the young ladies at Lorge. With lots of giggles and excitement the students happily accepted their packs. Like many of our experiences, this one ended with a circle of dancing and singing.

As we drove to the next school we shared our experiences and talked about how pleased we were with the way our presentations went. Jeannette told us that this school was really exceptional in the way it is run compared to other schools in the region. It was great to see teachers who are passionate about their work and how that reflects on their students. We set off with high expectations and drove down yet another dusty, bumpy dirt road. 

Kotintabig Jr. High School
At the next school, Kotintabig Jr. High, things had a different feel. It was a much bigger school and when we arrived we met with the vice principal under a tree in the yard. The students were again split up and we ventured out to meet our new groups. Classroom space was limited so several groups moved out under the shade of the large trees in the yard.  We quickly realized that the students didn't know who we were or why were there. As we introduced ourselves we noticed that there was more of a language barrier. Although English is the official language used in Ghanaian schools, many of the students had a hard time understanding what we were saying. They were all lovely and cooperative, and with the help of a teacher we did our best to make sure our words were understood.

Teaching under the trees
As we started our presentation we also learned that the students were between the ages of 9 and 17.  We were surprised by this after teaching at Lorge, where the students were all between 12-14 years old. As you can imagine it is difficult to teach sexual health when you consider the varying knowledge base of such a diverse group. Now add a language barrier and try to cram an entire sexual health presentation into one hour. It was tough, but we somehow made it through the material and at the end had an anonymous question box. While we answered as many questions as we could, we left with heavy hearts when we ran out of time. Reading through the unanswered questions on the bus was a hard blow to realize that some students had not understood what we were saying.

Sexual health is so incredibly important. It can be a difficult subject to talk about and I am grateful our group had the opportunity to share our knowledge. As nurses we hope to connect with our communities and do the best we can for them. Sometimes it's hard to meet the needs of an entire community and when this happens you can question your methods. I know many of us would have liked more time and may have done things a bit differently if we could. However, there were many students who learned a lot from our presentations. Things don't always work out the way you expect (which is something we are becoming very familiar with in Ghana), but this is how we learn and grow in our practice.

- Victoria Cluett 

Tuesday, April 5, 2016

Two Chickens and a Bus!

Nyboko Chief
A huge piece of our practice in Ghana is creating and maintaining relationships with our partners and their communities. With this, comes a lot of meet and greets.

A day that really put this into perspective for us was when we arrived in Bolgatanga and needed to meet all our partners before we began our practice. We all loaded onto our trusty bus early in the morning expecting to go out for a few meetings. Around twelve stops and about nine hours later, we had met more people than we ever could have imagined. However, every person was a very important piece in relation to our work being done in and around Bolga. Included in these stops were 3 different nursing schools, our 3 rural clinic placements, a local government, the regional health director's office as well as 2 different Chief's Palaces. 

Nyboko Community at Work
Building Teacher Accomodations

One of the highlights of the bus tour was an unexpected stop at the primary school in Nyoboko. There were a few men building a teachers' residence with mud.  Vida took this as an opportunity to check in with the community and for us to learn and see how these men were working. A few of the girls also took this as an opportunity to teach the school children the chicken dance.  Another highlight of these stops was one of our meetings with the Nyboko Chief. We met him beneath a large shade tree where he greeted us in his local language and sat on a mat of cow and goat hide. This meeting ended with a gift of 2 live chickens. Jeanette was very excited to accept the gift, despite her crippling fear of birds. However she faced this fear and graciously accepted. We got them all tied up and they came along with us for the rest of the day. 

It was a long day, but at this point, we all understand the importance of making these connections and relationships. It becomes difficult, (not only for us but our Ghanaian colleagues) for us to show up to work without first making our first meetings and stating our goal and purpose of being here. It would be just as strange if a group of strangers showed up to our place of work in Canada without first establishing some rapport with us. We feel our practicum here in Ghana remains strong because of these connections and the importance we place on these cultural pieces.

Although these sorts of days have been long and tiresome for us, I know I will always look back on them with a full heart and remember the many people and interesting situations we have experienced upon meeting with our Ghanaian colleagues. 

By Mara 

Sakote Clinic

Sakote Crew

We  (Myrte, Nicole, Kelsey, Dawn, and Kath) were warmly welcomed into Sakote by the Chief and the staff at the clinic. We were surprised to learn that there were 10 staff members working at the clinic, including a midwife, community health nurses and general nurses.  The staff all live right at the health centre and are able to provide services in emergencies after hours.

Firstly, we learned how to run the consultation room. The practice of the consulting nurse differs from our scope of practice because they are responsible for diagnosing and prescribing medications. They make their decisions based upon algorithms that they follow.  Larger clinics will have a Nurse Practitioner or Physican Assistant for consulting, but in these smaller rural clinics, consulting is the responsibility of the nursing staff.  The scale of conditions that could be diagnosed and treated was minimal as the centre was only equipped to treat a handful of diseases, most commonly malaria and respiratory infections.
The HIV and malaria test kits are effective because they are quick and easy to use. In the case that a diagnosis could not be treated at the clinic, the nurse referred the patient to a larger clinic or hospital.  The nearest larger centre, the Nangodi Health Centre, is about 12 km down a rough gravel road.  The nearest hospital is in Bolgatanga, another hour drive on rough roads.  Many patients do not have access to transportation to the larger centres and they must walk.  Unfortunately, many are unable to follow through with the referral.

One of the biggest challenges we faced was communication. Due to the high number of dialects throughout Ghana, this can even be challenging for nurses working in clinics. Luckily, some of the staff were able to translate our assessment questions, followed by recommendations and teachings. 

The clinic also provided routine checkups which included an HIV test and blood pressure. Vida spread the word that we were doing health screening, and the number of people seeking routine checkups was encouraging, even the Chief and his wife came out to show their support of the screening program. 

Sylvia, the midwife, was knowledgeable in teaching us about antenatal assessments. She sees patients both at the clinic and in the community.  We were fortunate to be there on the day the "ultrasound medic" traveled to the clinic with a portable ultrasound machine (this only happens once a month). 

Our collaboration with Ghanaian healthcare workers was an invaluable tool during this experience. We feel even more immersed into Ghanaian culture as they taught us how to eat banku and pump water from the well!

Friday, April 1, 2016

As Happy as can Bee!

The Logre Team
Working at the Logre Catholic Health Center gave us nothing but good feelings. Logre is just outside of a small town called Kongo, about 45 minutes outside of Bolga.  This clinic is run beautifully by the dedicated and hard working staff. Each day they provide a variety of health care services, some of which include: antenatal clinics, child welfare clinics, mental health assessments, and HIV treatment and drug dispensary. The outpatient department and maternity ward are also open around the clock for walk ins and routine community care. This clinic a perfect example of primary and preventative health care and we could learn a lot from them. 

 While working here for a few days we learned how to provide necessary nursing care with minimal resources available. For example prenatal assessments without ultrasound or fetal doppler.
In simple terms, this clinic showed us the true authenticity of nursing practice by demonstrating to us that nursing is an art and that the most important tools we need are knowledge, our hands and our hearts. 

Mama Bee with Paige
The staff here were very welcoming and were always open to hearing how our services differ from their's. One staff member in particular will forever be in our hearts. Beatrice, also know as Mama Bee, is the senior midwife and one of the clinic supervisors. She radiates passion for what she does. Mama Bee lives behind the clinic and works around the clock even when the clinic is closed. While this may seem exhausting to some, Mama Bee never stops smiling or giggling. She runs the HIV clinic every Friday. There is a huge stigma in Africa around HIV and AIDS where many individuals are shunned from their families, communities and villages. Many do not come to the clinic because they are afraid someone will stigmatize them. Mama Bee will hand deliver the medications to these individuals out in the community or they will come to her house late at night when no one is around. In her own words "if I do not do this these people will die". She will hand deliver these medications by foot! When the HIV medication supply is low she will go to the pharmacy and buy more from her own pocket. She does not get reimbursed and does it out of the goodness of her heart. She is a very influential nurse to learn from and her passion is contagious. 
Mama Bee Schooling Us

Thank you Logre for a fantastic experience!

~Alyssa Sand, Paige Bunbury, Melanie Hameluck and Madison Phemister